Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed.

Association between air pollution and COVID-19 mortality and morbidity.

Coronavirus disease (COVID-19) pandemic is affecting the world unevenly. One of the highest numbers of cases were recorded in the most polluted regions worldwide. The risk factors for severe COVID-19 include diabetes, cardiovascular, and respiratory diseases. It has been known that the same disease might be worsened by chronic exposure to air pollution. The study aimed to determine whether long-term average exposure to air pollution is associated with an increased risk of COVID-19 cases and deaths in Poland. The cumulative number of COVID-19 cases and deaths for each voivodeship (the main administrative level of jurisdictions) in Poland were collected from March 4, 2020, to May 15, 2020. Based on the official data published by Chief Inspectorate of Environmental Protection voivodeship-level long-term exposure to main air pollution: PM2.5, PM10, NO2, SO2, O3 (averaged from 2013 to 2018) was established. There were statistically significant correlation between COVID-19 cases (per 100,000 population) and annual average concentration of PM2.5 (R2 = 0.367, p = 0.016), PM10 (R2 = 0.415, p = 0.009), SO2 (R2 = 0.489, p = 0.003), and O3 (R2 = 0.537, p = 0.0018). Moreover, COVID-19 deaths (per 100,000 population) were associated with annual average concentration of PM2.5 (R2 = 0.290, p = 0.038), NO2 (R2 = 0.319, p = 0.028), O3 (R2 = 0.452, p = 0.006). The long-term exposure to air pollution, especially PM2.5, PM10, SO2, NO2, O3 seems to play an essential role in COVID-19 prevalence and mortality. Long-term exposure to air pollution might increase the susceptibility to the infection, exacerbates the severity of SARS-CoV-2 infections, and worsens the patients' prognosis. The study provides generalized and possible universal trends. Detailed analyzes of the phenomenon dedicated to a given region require taking into account data on comorbidities and socioeconomic variables as well as information about the long-term exposure to air pollution and COVID-19 cases and deaths at smaller administrative level of jurisdictions (community or at least district level).

Prevalence of lower urinary tract symptoms in patients with cardiovascular disease.

INTRODUCTION: The presence of lower urinary tract symptoms (LUTS) might be linked with elevated cardiovascular risk. There is a lack of data showing the prevalence of LUTS in the population of patients with cardiovascular diseases. The current study aimed to determine the prevalence of LUTS in patients hospitalized due to a cardiovascular disease. MATERIAL AND METHODS: Patients hospitalized in a tertiary cardiology department due to a primary diagnosis of cardiovascular disease (including coronary artery disease, heart failure and arrhythmia) were included in the study. All patients were screened for LUTS and assessed using the International Prostate Symptoms Score (IPSS). RESULTS: From 166 patients (age 62.8 ±12.1 years), moderate to severe LUTS was diagnosed in 62 patients (37.3%). Patients with LUTS were significantly older, but there were no other factors associated with LUTS. When we divided patients according to LUTS severity, we saw an increasing prevalence of arterial hypertension (69.5% vs 72.9% vs 100%), diabetes mellitus (29.5% vs 33.3% vs 38.5%), coronary artery disease (68.6% vs 72.9% vs 92.3%), but the observations were not statistically significant. Patients with coronary artery disease had significantly higher severity of LUTS compared to patients with arrhythmia or heart failure (mean IPSS 8.88 vs 5.6 vs 5.5, p = 0.004). CONCLUSIONS: The prevalence of LUTS in patients with cardiovascular diseases is high, affecting 37.3% of the studied population. Patients with coronary artery disease have significantly higher severity of LUTS compared to other cardiovascular diseases.

Acute Myocardial Infarction Due to Antiphospholipid Syndrome - Case Report and Review of the Literature.

We present a case of acute myocardial infarction secondary to arterial thromboembolism in a 25-year-old man with systemic lupus erythematosus and antiphospholipid syndrome (APS). To our knowledge, based on the literature review, this patient is the youngest one with the acute coronary syndrome as a complication of APS. Acute myocardial infarction secondary to arterial thromboembolism is a rare presentation of APS. There are different recommended anticoagulation strategies in APS patients according to the presence of thrombosis of arterial or venous origin. Potential difficulties in the treatment may occur based on the clinical scenarios. A large number of APS patients require lifelong oral anticoagulation with vitamin K antagonists. Some non-vitamin K oral anticoagulants are being studied as drugs potentially useful in APS treatment. The recent studies suggest the role of aGAPSS score in assessing the risk of a recurrent thrombotic event as well as acute myocardial infarction in APS patients.

Prevalence of obstructive sleep apnea in patients with peripheral arterial diseases.

BACKGROUND: The presence of obstructive sleep apnea (OSA), a novel cardiovascular risk factor, contributes to the development of peripheral arterial diseases (PAD). There is a lack of data showing how often these diseases coexist. AIMS: The aim of the study was to determine the prevalence of OSA in the population of patients with PAD. METHODS: Patients previously qualified for the first revascularization due to PAD were included in the study. All patients underwent an overnight sleep study to detect OSA. Diagnosis of OSA was made when the apnea-hypopnea index (AHI) was ≥5 per hour. RESULTS: From 141 patients (60% men, age 69.6 ± 9.5 years), OSA was diagnosed in 68 patients (48%). OSA occurred in mild form (5 ≤ AHI < 15/h) in 39 cases (28%), in moderate form (15 ≤ AHI < 30/h) in 21 cases (15%), and in severe form (AHI ≥ 30/h) in 8 cases (6%). Patients without OSA had significantly lower body mass index (BMI; 26.9 ± 5.5 vs. 27.7 ± 5.3 kg/m2, p = 0.01) and lower hip circumference (97.4 ± 11.7 vs. 98.7 ± 7.4, p = 0.04). There were no differences in the distribution of other investigated cardiovascular risk factors and diseases between these groups. There were no significant differences in OSA distribution or its severity between patients with lower extremity artery disease and carotid artery disease. CONCLUSIONS: The prevalence of OSA in patients with PAD is very high, affecting nearly half of the studied population.

Correlations between Vancouver type of periprosthetic femur fracture and treatment outcomes.

OBJECTIVE: Periprosthetic femur fractures are one of the most severe complications of total hip arthroplasty. METHODS: The aim of this study was to assess outcomes of periprosthetic femur fractures based on the Vancouver classifications of fractures. RESULTS: Sixty-four patients were enrolled into the study. Type B1 fractures were the most common - 33 cases. In comparison to patients with type B3 fracture, patients with type B1 fracture significantly less often experienced postoperative pain. CONCLUSION: Study shown that in the context of both objective outcomes of the operation and patient satisfaction, the most unfavourable prognosis is after type B3.